Despite considerable advances over recent years in palliative care, end of life care, and the assessment of quality of life (QoL), little work has specifically addressed means of improving overall quality at end of life. Attention to the spiritual aspect of QoL, notwithstanding increasingly widespread acknowledgement of its importance, has been especially limited. Interventions to improve quality at end of life are needed with particular urgency to address the needs of the large and growing population of patients with AIDS in the US, a group subject to bereavement at end of life often compounded by isolation and alienation. On the basis of prior literature, meditation, and specifically Metta meditation, is promising as an intervention uniquely suited to meet spiritual needs at end of life. Of note, while meditation has the potential to address spiritual needs, it does not necessarily compensate for the benefits of physical contact. Among patients with AIDS subject to a sense of physical isolation, the benefits of meditation could be blunted unless the need for physical contact is also addressed. Whether the benefits of meditation and physical contact such as massage are interchangeable, independent, additive, or even synergistic is as yet unknown. We therefore proposed a randomized, controlled, single-blind 2X2 factorial pilot study of Metta meditation, with and without massage, to determine the effects on QoL among late-stage patients with AIDS at an AIDS-dedicated skilled nursing facility in Connecticut. The Missoula-Vitas QoL survey, a validated instrument for end-of-life, will be used to measure the independent and interdependent effects of meditation and massage on QoL during, immediately post, and late post-intervention in subjects randomly assigned to each of 4 treatment conditions. The meditation intervention will consist of initial instruction by an expert in the technique, followed by self-administration with audiocassettes. A certified massage therapist will provide the massage intervention. The methods to be tested in the proposed study are inexpensive, and do not require specialized facilities, and thus offer the promise of widespread application if proved effective. By addressing high priority aspects of end of life care for patients with AIDS in a methodologically rigorous manner, the proposed pilot study has considerable potential to advance the standards of care for this large, growing, and particularly needful population.